Concurrent Child and Adolescent Day Treatment and Residential Treatment Services remain subject to medical necessity and non-duplication requirements.
Topics Related to Medicaid Managed Care
A new prior authorization is required for NC Medicaid Managed Care beneficiaries returning to NC Medicaid Direct.
This bulletin clarifies NC Medicaid billing requirements to ensure proper submission of laboratory services.
Effective July 1, 2026, local education agency claims submitted to NCTracks must include the individual ordering, prescribing or referring and rendering provider’s National Provider Identifier.
With the launch of the Children and Family Specialties Plan (CFSP), NC Medicaid enacted policy levers to promote continuity of care for CFSP members and ease the administrative burden on providers. For more information, see the Provider Bulletin from Oct. 13, 2025.
The following policies will expire June 30, 2026. These include:
Local Health Departments will continue to offer Care Management for At Risk Children and Care Management for High-Risk Pregnancy services to Medicaid beneficiaries, with Per Member Per Month payments remaining in effect, both through Dec. 31, 2026.
Action Required: Providers with Active 251S00000X Taxonomy must select New Service and Report National Accreditation.
Modifier CR should only be appended to procedure codes when services are directly related to a Federal or State-declared emergency or disaster.
The Centers for Medicare & Medicaid Services has released 80 new ICD-10-PCS codes, Effective April 1, 2026.
Following stakeholder engagement and review of departmental priorities, NC Medicaid will not be implementing the Advanced Medical Home (AMH) Standardized Performance Incentive Program (SPIP) at this time.